The HiSLAC project aims to examine the impact of consultants and associate specialists on reducing the mortality associated with weekend admission to hospital, as part of an independent evaluation of seven-day services.
On June 16th 2016 the project released our third annual Point Prevalence Survey of specialist involvement in emergency admissions. All consultants and associate specialists from all specialities in participating acute Trusts across England were invited to complete a very short web-based survey to determine the number of specialists physically present and providing care for acute admissions on a given Sunday and Wednesday in June. The survey has now closed but reports will be returned to trusts in September.
Over 14,000 consultant and associate specialists completed the surveys in 2014 and 2015. The survey will be run every year until 2018 to investigate trends in specialist intensity at weekends and analyse this with patient outcomes. The results from the 2014 baseline survey were recently published in the Lancet in which we analysed weekday-weekend differences in specialist intensity with weekday-weekend differences in patient mortality. In this cross-sectional study we did not find an association but we need to complete our longitudinal study for a definitive answer. This article is available through our ‘publications’ tab.
The HiSLAC survey and project is supported or endorsed by NHS England, The NHS Confederation, the Academy of Medical Royal Colleges, The Royal College of Emergency Medicine, The Society of Acute Medicine, The Royal College of Physicians, The Faculty of Intensive Care Medicine, The Royal College of Anaesthetists, the Queen Elizabeth Hospital Birmingham, and the Universities of Birmingham, Leicester, and Warwick.
Frequently Asked Questions about the survey can be found below
What is your definition of a specialist?
We are defining a specialist as a doctor who has obtained a certificate of completion of specialist training (CCT). This will include specialists, staff-grade and non-consultant career-grade doctors i.e. all CCT holders (eg: consultants + associate specialists).
Which specialists (specialities) will you want included in the point prevalence survey?
We request that local project leads send the point prevalence survey to all hospital consultants, associate specialists and honorary specialists (including clinical academic staff) who work within the trust. This will therefore include not only physicians and surgeons, anaesthetists and intensive care specialists, but also radiologists, microbiologists, palliative care medicine, pathologists, and laboratory consultants, amongst others.
By ’providing acute specialist services’, are you referring also to providing care to any inpatient (such as routine ward round or inpatient referrals etc), or just duties specific to the acute medical take?
We are referring to all adult in-patients who were admitted to hospital as an emergency, regardless of where they are in their subsequent in-hospital pathway. We do not therefore include patients admitted to hospital electively (eg: many surgical procedures) but who subsequently develop complications during the hospital admission, or patients referred for second opinions on disease processes for which they underwent elective hospital admission. We do not include out-patients or clinic patients.
Will everyone need to fill in the questionnaire, or just those providing acute specialist services on the days in question?
The survey will need to be sent to all specialists that could have provided care on either of those days – essentially, all hospital specialists. All clinicians who were sent the survey will need to complete it, even if they were not on duty on those days, so that we can calculate a response rate. From the local project lead we would need to know the number of individuals to whom the survey was sent (usually the number of email addresses in the distribution list ‘all consultants’ or ‘all specialists’ in the Trust email system).
I happened to be on annual leave for the dates mentioned, should I complete the survey as if it were a normal week for me?
No, the survey is a snapshot of specialist intensity on those particular days. Please complete the survey for those particular days.
Are you including time spent with patients in the emergency department?
Emergency Medicine specialists should estimate the amount of time they spent caring for patients who were admitted to hospital.
I have more than one CCT, which speciality should I choose? The CCT I have is not in the speciality I consider I spend most of my time, which speciality should I choose?
We realise that many specialists hold more than one CCT, whereas others may practice full time in a speciality which at the date of completion of training did not provide a CCT (eg: acute medicine, intensive care medicine). Please choose that speciality which best reflects your practice on the two survey days.
Will you know who has and who hasn’t filled in the questionnaire?
As tracking individual responses or non-respondents is both technically difficult and challenging from a data governance perspective, we will not be requesting or recording any individual identifiers. We will ask local project leads to tell us the number of individuals who were sent the survey (the denominator), from which we will be able to determine the response rate for each Trust. It will almost certainly be necessary to send one or more reminder emails to maximise response rates. Local project leads will be informed of the response rate each week.
What kind of response rate will you require from the point prevalence survey?
As high as possible, both for data validity and to demonstrate professional engagement with, and ownership of, the HiSLAC project.
A site at my Trust takes a very small number of medical admissions but only Monday – Friday 9am – 7pm. There are no acute medical admissions to this site in evenings, overnight or at weekends. Will this site also be included in the survey?
We would like to capture information from all specialists who provide care to any patient admitted as an acute emergency. The differences in extra capacity due to additional sites being open during the week compared to ‘out–of-hours’ is data we would wish to collect as the project unfolds. We will need your help to understand local circumstances.
I am a specialist who works at multiple sites. How will my data be collected for the point prevalence survey?
Although we understand that some specialists will work across Trust sites and even in sites at different Trusts, unfortunately we will not be able to capture this level of detailed information in this survey. We would ask specialists to identify the site where they spend the majority of their time and then answer the proceeding questions as if they apply to all sites.
We have on call specialist physicians covering multiple sites 24/7 that input actively into the AMU at weekends. How will these specialists be accounted for in your metrics?
This information cannot be captured in the staff-level point prevalence survey, but it can be described in a separate Directorate-level questionnaire which we will ask local project leads to complete in conjunction with the acute medical specialities. Local project leads will be offered the opportunity for a telephone interview to discuss the questionnaire. During this interview, additional complex information can be collected and incorporated into our aggregated dataset.
Some diagnostic and laboratories specialties may not be on site but provide the same level of service (i.e telephone advice) as we do when we are on site, how will this be dealt with?
For consultants that do not usually have a face-to-face patient contact (for example those involved in diagnostic services), If you are able to provide the same level of service off-site as well as on site, please answer the question as you would if you were on-site for those survey days.
Written on Thursday, 18 June 2020
HiSLAC PI Prof Julian Bion features in this month’s @TheDrMagazine in his role as Freedom to Speak up Guardian… twitter.com/i/web/status/1…
Written on Thursday, 09 January 2020
“The search for the cause of the #weekendeffect clearly needs to include community services…it is the whole patie… twitter.com/i/web/status/1…
Written on Thursday, 02 January 2020
Read HiSLAC PI, Prof Julian Bion’s editorial, “Weekend effect: complex metric for a complex pathway”… twitter.com/i/web/status/1…
Written on Tuesday, 24 December 2019
Merry Christmas from all the HiSLAC team!